Electronic Health Records

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EHR tool improves care transitions for pediatric patients

By Jennifer Bresnick

An EHR tool intended to help clinicians communicate better during transitions of care was highly effective in reducing preventable readmissions and adverse events while pediatric patients were still in the hospital.  The study, published in the most recent issue of JAMA, used both electronic and verbal strategies to standardize the hand-off procedure to prevent miscommunications and gaps in information during shift changes or transfers.

Two inpatient units at Boston Children’s Hospital participated in the study.  Both units were trained to use a mnemonic device to ease care transitions.  “I-PASS” stands for illness severity, patient summary, action list situation awareness and contingency planning, and synthesis by receiver.  One of the wards was also given a documentation template linked to EHR data to standardize patient information without resorting to error-prone free text input.  The tool improved performance in 11 out of 14 of the metrics tracked in the study compared to only 2 of 14 categories in the unit that only had the mnemonic device.

The system reduced medical errors and adverse events significantly in both cohorts, however.  Errors decreased from 33.8 errors per 100 admissions to 18.3 errors, while preventable adverse events were cut in half from 3.3 per 100 cases to 1.5 per 100 patients.  With 29% of physicians admitting that poor patient hand-off procedures have led to an adverse event, the results are highly encouraging for patient safety and hospital quality.

“Traditionally, doctors are trained in medical school to interview a patient and write daily summaries of the care plan but though vital to patient care, [they] rarely receive communication or handoff training,” said lead author Amy J. Starmer, MD, MPH, from the Division of General Pediatrics at Boston Children’s Hospital.  “We believed these systems would lead to a reduction in medical errors, but did not expect to see a change of this magnitude.  And even more surprising was that the systems were introduced so easily. Participants embraced the new system, became more productive, and could then focus more energy to the job at hand.”

After the study, physicians were less likely to omit critical pieces of information during transitions and were more likely to spend more time at the patient’s bedside.  They were even more likely to move to a quiet or private area to communicate patient information.  While an accompanying editorial calls into question some aspects of the study’s rigor, the value of training physicians to pay attention to issues surrounding continuity of care is beyond debate.  The strategy is now being introduced into 10 teaching hospitals nationwide.




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